Prenatal care diagnosis and nursing measures

The three most common types of prenatal care diagnoses in clinical practice are: Abnormal emotional state (mainly anxiety/fear), impaired physical comfort, lack of knowledge about pregnancy and childbirth , the corresponding core nursing principle is "individualized layered support". There is no unified template suitable for everyone. All measures must be adjusted based on the physical condition, psychological acceptance, and family support of pregnant women.

We obstetrical nurses often say privately, "Every prenatal checkup, first look at the face and then the report." This is really not something we say casually. Last week, I met a 32-week-old mother of her second child at the outpatient clinic. Her first child had undergone an antegrade cesarean section. During this time, she posted a lot of posts about critical pregnancy and childbirth. She only slept 3 hours a day for half a month. All indicators in the prenatal checkup report were normal. When she sat down, the first thing she said was, "Doctor, will something happen to me during delivery?" In response to this type of emotional problems, there are actually two different ideas in the industry: one is the collective psychological education commonly used in public hospitals. A class for pregnant mothers is held once a week to unify the science of childbirth risks and coping methods. The advantages are wide coverage and low cost. It is suitable for generally alleviating group anxiety, but it is weakly targeted. Pregnant mothers who have had traumatic childbirth experiences like this may find it easier to settle in after listening. ； The other is the one-to-one peer support + mindfulness intervention promoted by private hospitals and some specialist hospitals. It involves talking to mothers who have also experienced antegrade tumours, and who have successfully given birth. This is combined with 15 minutes/day of breathing meditation training. It has a particularly good relieving effect on specific groups of people. The disadvantage is that the labor cost is high and it is difficult to promote on a large scale. My own experience is that if a pregnant mother's anxiety has affected her sleep and diet, don't wait for a group class and talk directly to the obstetrical psychology nurse, which is much more useful than imagining on your own.

Many pregnant mothers complained to me before, saying that they could not sleep during the third trimester of pregnancy, or their feet were swollen like steamed buns, or their pubic bones hurt when they turned over. This is the second most common nursing diagnosis: impaired physical comfort. When many people see edema, they say they should drink less water and lift their legs more. The last time I met a 34-week pregnant mother, my mother-in-law said that edema should be controlled. She only drank one cup of water a day for three days in a row. When she came for a prenatal check-up, her urine test showed three positive levels of ketone, and she was almost hospitalized. There is also a controversial point here: Should I use an abdominal support belt to relieve back pain? The view of some rehabilitation departments is that long-term use of abdominal support belts will disuse the core muscles and affect postpartum recovery. ； But our frontline obstetrics department prefers "situation-specific use" - if you are a pregnant mother who needs to stand for work every day and walk a long way, wearing an abdominal support belt can reduce about 30% of the pressure on the lumbar spine when you go out. If you take it off while lying down and sitting at home, there will be no negative effects at all. There is no need to stick to the standards of a certain school. There are also pregnant mothers who suffer from pubic symphysis separation and pain. Don’t carry it and walk more. Use a pelvic belt to fix it and put a pillow between your legs when sleeping. It is more effective than any folk remedies.

The third type of problem is lack of knowledge, and more people fall into traps. Last month, I had a primiparous mother who was 39 weeks old. I heard someone said that climbing more stairs would improve her health. She climbed 20 floors a day. Finally, she was so red that she came to the emergency room. When she checked her cervical canal, it was almost gone. Fortunately, there was no premature rupture of membranes. There are now two directions for publicizing knowledge about pregnancy and childbirth: one is the traditional brochure issued according to the week of pregnancy, which clearly lists taboos and precautions. The advantage is that it is authoritative and accurate, but many pregnant mothers cannot read it at all. ； The other is the short video science popularization and simulated delivery room experience that many hospitals now do. A pregnant mother I managed before was still scared after watching the birth science popularization three times. She entered the simulated delivery room, touched the midwifery ball, and listened to the normal contraction monitoring sound. She said on the spot, "It doesn't seem that scary." Oh, by the way, there is another controversial point: Do I need to prepare milk powder before giving birth? Advocates of exclusive breastfeeding are firmly opposed to breastfeeding, saying it will affect the confidence in breastfeeding after delivery, but we in the clinical field generally recommend preparing a small can of 400g. After all, in the first 72 hours after giving birth, some mothers do not have enough milk due to physical reasons, and they cannot let their newborn babies go hungry. Both views are correct, but they are just from different perspectives.

I have been an obstetric nurse for 6 years. In fact, I feel that one of the potential nursing diagnoses that is most easily overlooked is "family coping disorder" - many people focus on the state of pregnant women and forget that fathers-to-be or family members accompanying them will also be anxious. I have seen many fathers-to-be who are more nervous than pregnant mothers. They ask more than a dozen questions at every prenatal check-up, and then turn around and pass the anxiety to the pregnant mother, which in turn puts a burden on the mother. At this time, we actually need to provide simple education to the family members, such as telling them not to talk about "will something happen" every day, and to help them remember the time of prenatal check-ups and rub their legs, which is more effective than saying "don't be afraid" a hundred times.

To put it bluntly, prenatal care is never an assembly line work based on guideline templates. Some pregnant mothers are afraid of pain, so they tell her more about painless delivery. Some pregnant mothers are concerned about their weight and help them calculate their caloric intake during pregnancy. Some people need to be comforted, and some just need you to tell her "this indicator is okay." The core is never to complete all nursing measures, but to really see the specific needs of the pregnant woman in front of you.